role of aspirin in thrombotic thrombocytopenic purpura: a randomized control trial

To assess the safety and efficacy of aspirin in acute Thrombotic Thrombocytopenic Purpura [TTP] and to evaluate it as a maintenance therapy. Randomized controlled trial. Hematology/Oncology Department, Salmaniya Medical Complex [SMC], Kingdom of Bahrain. Nine patients with TTP admitted between August 2003 to December 2005 were included in the study. Seven were females [77.8%] and one was pregnant. Five Patients were randomized to receive the standard therapy with aspirin [group I] and four [group II/control] received the standard therapy only [plasma exchange, one single plasma volume daily using fresh frozen plasma from healthy donors and Methylprednisolone 1 gram intravenously once daily for three days]. Safety and efficacy of aspirin were assessed during the acute phase [4 weeks] and as maintenance for one year. Statistically significant reduction in the number of plasma exchange sessions were noted in the aspirin group [p = 0.0315]. Other parameters such as days of hospitalization, red blood cells transfusion were lower in the aspirin group compared to non aspirin group. No cases of mortality or morbidity were observed in patients receiving aspirin. Two patients [50%] developed deep vein thrombosis [DVT] in the control group and one of them eventually died [25%]. Though these were statistically insignificant, possibly due to the small number of patients, it would suggest the efficacy of aspirin in TTP. The study showed a significant reduction in the number of plasma exchange sessions in the aspirin group and probable advantages. Accordingly, we recommend a multicenter RCTs to address the role of aspirin in the management of TTP patients

Polymorphisms in NOS3, ACE and PAI-1 genes and risk of spontaneous recurrent miscarriage in the Gaza Strip

This study was conducted to investigate the correlation between spontaneous recurrent miscarriage [RM] and common polymorphisms in angiotensin-converting enzyme [ACE], plasminogen activator inhibitor 1 [PAI-1] and endothelium-derived nitric oxide synthase 3 [NOS3] genes among women experiencing RM in the Gaza Strip. The presence of these genetic profiles was determined for 100 women who had had at least 3 constitutive abortions and 100 controls without any history of abortion using molecular biological techniques. The ACE D/D polymorphism was present in 49% of the study population and in 54% of the controls [p = 0.479]. Similarly, there was no significant difference detected in the distribution of polymorphisms for PAI-1, with the 4G/4G genotype present in the study group and in controls [p = 1.00]. NOS3 4a/4a was present in 4% of the study group and in none of the 100 controls [p = 0.123]. In this study, we also discovered a new variant in the NOS3 gene which was named 4c allele and was encountered in 1 patient and in 1 control subject. There was no significant association between ACEI/D, PAI-1 4G/5G and NOS3 4a/4b and the occurrence of first-trimester RM. In-depth investigation of the association of NOS3 4a/4a with RM is strongly recommended

Calpain-10 gene polymorphism in type 2 diabetes mellitus patients in the Gaza strip

To examine the role of calpain-10 SNP-44, -43, -63 and del/ins-19 in genetic susceptibility to type 2 diabetes mellitus [T2DM] and associations with triglycerides and total cholesterol in a group of subjects residing in the Gaza Strip. Ninety-six individuals were examined: 48 T2DM patients and 48 controls. The groups were genotyped for calpain-10 SNP-44, -43, -63, and del/ins-19. Mutagenically separated polymerase chain reaction was used to examine SNP-44; del/ins-19 was examined by electrophoresis of the PCR product on agarose gel, while the restriction fragment length polymorphism method was used for SNP-43 and -63. There was evidence that the C allele at SNP-44 played a possible role in susceptibility to T2DM [p = 0.01]. T2DM patients with G/A genotype were found to have higher levels of total cholesterol in comparison to those homozygous for allele 1 [G/G] in SNP-43. Total cholesterol levels increased in T2DM patients who are homozygous for del/ins-19 allele 2, in T2DM patients with the 121/221 haplotype combination, and in control subjects with the haplotype combination 111/121. SNP-44 polymorphism of the calpain-10 gene has a significant association with T2DM patients in the Gaza strip. Certain polymorphisms of calpain-10 also have associations with the levels of total cholesterol in both T2DM patients and controls

Relation between brain natriuretic peptide [BNP] and congestive heart failure among hypertensive patients in Gaza strip

Brain natriuretic peptide [BNP] has been established as a new and reliable laboratory marker for congestive heart failure [CHF]. BNP is a neurohormone secreted by the cardiac ventricles in response to volume expansion and pressure overload. This study aimed to ascertain whether an association exists between the level of BNP hormone and CHF among hypertensive patients. Retrospective design [case-control study] was used to collect data from 75 patients with CHF and history of hypertension [case group], and 75 patients with history of hypertension only [control group]. CHF subjects consisted of fourteen subjects with acute heart failure, and fifty six subjects with chronic heart failure. CHF group was also classified into four classes; the diagnosis and classification of CHF were done according to the New York Heart Association [NYHA] by two cardiologists. Self report structure interview and Ethylenediamine tetracetic acid [EDTA] blood samples were obtained from both groups. In this study we used Abbott AxSYM in conjunction with a recently available immunoassay kit for BNP hormone MEIA [Microparticles Enzyme Immuno Assay] system. T-test, Kruskal-Wallis and ANOVA-I were used to analyze the data. The results of the study showed a significant relationship between BNP hormone and CHF [P value=0.00]. The obtained data suggest that the measurement of BNP levels may be helpful in the diagnosis and prognosis of CHF and in selecting patients for further evaluation

RHD gene polymorphism among Palestinians of Gaza strip

Rh system is one of the highly complex blood group systems with many serologically defined Rh antigens. These antigens are expressed by proteins encoded by a pair of highly homologous genes located on chromosome 1. RHCE gene encodes the CcEe antigens, while the RHD encodes the D antigen. RhD is the most important, immunogenic and polymorphic Rh antigen from the clinical aspects [comprising at least 30 epitopes], as it plays a key role in transfusion medicine. Anti-D antibodies remain the leading cause of the hemolytic disease of the newborn [HDN], and antigen D compatible transfusion is a standard practice in transfusion therapy. Partial D lacks one or more D epitopes, and a partial D individual may be immunized on exposure to a normal D positive during blood transfusion or pregnancy. The DVI and DNB variants are the most frequent partial Ds that lack some D epitopes, DVI is usually typed as D negative while DNB is typed as D positive. We have examined 102 genomic DNA samples collected from blood donors expressing D positive [79 samples] and negative phenotypes [23 samples], to detect DVI and DNB variants, and to investigate the molecular basis of Rh negative phenotype. To verify the DVI variant; simplex PCR was used to detect the presence or absence of RHD exon 10/intron 4, while PCR-SSP was used to detect the DNB variant. Three DVI and three DNB samples were detected. The PCR results indicated a deletion of RHD gene in D negative specimens. The results show that the frequency of the DVI phenotype in Palestinians is greater than expected and routine screening for this phenotype should become mandatory for equivocal weak D blood samples

[ comparative study of patients with pulmonary tuberculosis and extrapulmonary tuberculosis in Kashan during 2002-7]

Background: many studies have shown that the extra-pulmonary tuberculosis is growing compared to the pulmonary one. This study was carried out on under-treatment TB patients in order to evaluate the comparison of pulmonary and extra pulmonary TBs in kashan

Materials and Methods: the study was carried out on available data and the medical documents of TB patients treated in "Kashan TB Center" during a five year-period [2002-7]. All relevant data regarding the treatment were collected based on the definition presented by "Iranian Defense Guidelines against TB"

Results: one-hundred and three [52.6%] female and 93 [47.4%] male TB patients were studied 89 [45.4%] of who were Iranian and 107 [54.6%] was Afghani. The prevalence of pulmonary and extra-pulmonary cases were 130 [66.3%] and 66 [33.7%], respectively. The highest number of pulmonary TB was 72[55.38%] cases in female and extra-pulmonary TB was 35[53.04%] cases in males. Forty-six [69.6%] of extra-pulmonary patients completed their treatment period and 71[54.6%] of pulmonary patients were recovered completely. The most common clinical signs in pulmonary TB and in extra pulmonary TB were coughing [90%], sputum [87.6%] and weight loss [59.1%], night sweating [40.9%], respectively. The highest prevalent foci for extra-pulmonary TB were lymph nodes [19 [28.7%] cases] and bone [12[18.18%] cases]

Conclusions: the study showed that the prevalence of extra-pulmonary TB is one third of all TB cases. Therefore in the evaluation of non-specific findings of patients, TB must be considered

Viral, bacterial and parasitic etiology of pediatric diarrhea in Gaza, palestine

To determine the etiology of acute diarrhea in Palestinian children under 5 years of age and to improve knowledge of the etiology of gastrointestinal pathogens using traditional and molecular diagnostic techniques. Various common enteropathogens [viral, bacterial and parasites] associated with diarrhea were investigated by conventional and molecular techniques [PCR] in 150 children less than 5 years of age admitted to the Central Pediatric Hospital, Gaza Strip, Palestine. The occurrence of enteropathogens identified was as follows: rotavirus 42/150 [28%], Entamoeba histolytica/dispar 23/150 [15%], Shigella spp. 9/150 [6%], Campylobacter coli/jejuni and Escherichia coli O157:H7 7/150 [5%] each, Salmonella spp. 3/150 [2%], Giardia intestinalis 1/150 [1%], and Strongyloides stercoralis 1/150 [1%] of the samples. Shigella and Salmonella isolates were tested for their susceptibility to common antimicrobial agents and most of the isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. This study demonstrated that rotavirus, E. coli O157:H7 and Campylobacter, which are not routinely screened for in Gaza Strip, were significant enteropathogens. The results highlight the value of using a combination of traditional and PCR techniques in the diagnosis of enteropathogens related to gastroenteritis

[Effect of aqueous extract of origanum vulgare and melilotus officinalis on production of nitric oxide [No] in cultured vascular endothelial cells [mouse endothelioma F-2 cell line]]

During recent years, nitric oxide [NO] has been considered as a molecule involved in migraine headaches. This free radical involves in initiation of migraine headaches via NO/cGMP signaling pathway and vascular relaxation specially big intracranial arteries. Therefore, we studied the effects of aqueous extract of Origanum vulgare and Melilotus officinalis prescribed in migraine treatment in traditional and modern medicine, on NO level in cultured endothelial cells. Each crude herb [25g] was mixed with 200 ml distilled water. End extract obtained after filtering and drying. Endothelial cells propagated in DMEM medium containing 10% FCS and 1-2% penicillin-streptomycin. The nitrite concentration was measured as an indicator of nitric oxide production according to the Griess reaction and with ELISA in 540 nm. Concentrations of 100, 200 and 400 g/ml of Origanum vulgare, reduced NO levels compared with control to 13.1% [p<0.05], 25.8% [p<0.01] and 33.9% [p<0.001] respectively. However, despite our expectation melilotus officinalis increased NO level. The concentrations of 100, 200 and 400 g/ml of the herb, increased NO levels to 12.7 [p<0.05], 36.5% [p<0.001] and 72.9% [p<0.001] respectively. We concluded that aqueous extract of Origanum vulgare probably decreases migraine headaches by reducing NO and aqueous extract of Melilotus officinalis does not act through this mechanism

Rotavirus infection in infants and young children with acute gastroenteritis in Gaza, Palestine

To detect rotavirus antigen in infants and young children with acute diarrhea and gastroenteritis. Rotavirus is a major cause of gastroenteritis and diarrhea in infants and young children worldwide. Fecal samples from 150 children with ages ranging from 1 month to 5 years, living in Gaza, who presented with acute diarrhea episodes, were analyzed for rotavirus antigen. The analysis was carried out using an immunochromatography-based diagnostic kit [The Rota Stick One-Step test, Novamed Ltd, Jerusalem]. The study was conducted during the peak diarrheal season [May-August] of the year 2005. Rotavirus was detected in 28% [42/150] of the fecal specimens examined, and the majority of patients 90% [38/42], who were positive for the virus were 1 to 24 months old, and the infection rate decreased with increasing age. The highest rate of rotavirus antigen detection was observed among the 12 to 24 months age group 41.9%. Children infected with rotavirus were more likely to have watery stool [95.2%], vomiting [92.9%], moderate dehydration [14.3%] and fever has low frequency [73.8%]. The findings of this study demonstrate that rotavirus is one of the most frequently detected, yet a routinely neglected pathogen during stool examinations in Gaza strip health laboratories. Timely diagnosis of rotavirus infection in patients with acute diarrhea helps to determine appropriate treatment, prevents the unnecessary use of antibiotics and minimizes the spread of the disease. To our knowledge, this is the first report on occurrence of rotavirus infection among children of Gaza since 1994

Entamoeba histoloytica or entamoeba dispar among children in Gaza, Gaza strip?

Most physicians in Gaza prescribe medicaments for patient's suffering from Entamoeba histolytica/dispar without parasitologic diagnosis. Additionally, stool analysis performed by the routine methods usually reports the species as E. histolytica without confirmation. In this study, 92 stool specimens were collected and analyzed by wet mount, iron haematoxylin staining, antigen detection of E. histolytica and polymerase chain reaction [PCR]. The total number of E. histolytica identified by PCR was 64 that of E. dispar was 21. Mixed infection with both E. histolytica and E. dispar was evident in 7 specimens. In the light of these results, approximately 30% of suspected clinical amoebiasis cases were negative for E. histolytica. It is recommended to use PCR for diagnosis of stool specimens from patients with E. histolytica/dispar and that treatment should be prescribed for only patients positive for E. histolytica

Relationship between demographic characteristics and community-acquired urinary tract infection

To investigate the effect of age, sex and marital status on the etiology of community-acquired urinary tract infection and the antimicrobial resistance of uropathogens, urine specimens collected from 270 outpatients were analysed and 121 significant monomicrobial cultures obtained. The microorganisms were identified and their susceptibility to 14 selected antimicrobial agents was determined. These results were then related to the age, sex and marital status of the patients. This study concludes that understanding the effect of the different factors on community-acquired urinary tract infections and their antimicrobial resistance will aid the proper management of this disease

In-hospital mortality after acute myocardial infarction [prospective study]

Eighty-five consecutive patients with acute myocardial infarction [AMI] [67 males and 18 females] were studied in Medical Unit-III, Allied Hospital Faisalabad during 1990-91 for assessment of in-hospital mortality. Mean age at the time of infarction was 54 years [25-90 years]. Sixty-five [78%] had Q-wave infarction while 19 [22%] had non Q-wave infarction. Overall in-hospital-mortality was 16.5%. Mortality was higher in males compared to females [22% vs 5.3%] and Q-wave infarction compared with non-Q-wave infarction [20% vs 5%]. Similarly in-hospital-mortality was higher in patients with inferior infarcts, those having reciprocal ECG changes, arrhythmias and relatively high cardiac enzymes. In-hospital mortality was significantly low in patients receiving thrombolytic therapy with streptokinase compared with patients on nitrates and heparin alone

Renal carbuncle

A case of renal carbuncle was diagnosed with ultrasonography and computed tomography. The case was successfully treated with surgical open drainage

Abdominal tuberculosis

This is a report of 19 patients with abdominal tuberculosis. Nine patients presented with intestinal obstruction due to ileocaecal involvement, 3 had widespread disease with ascites, 2 presented with features similar to appendicular mass, 2 had ileal and extensive colonic involvement with ascites, 2 had colonic stenosis after completely healed lesions, and one patient presented with generalised peritonitis as a result of perforation from an ileocaecal lesion. Seventeen patients had laparotomies [15 resections and 2 biopsies], and the condition in the other 2 cases was controlled medically. There were no deaths or complications and post-operative anti-tuberculous treatment continued for one year